Provider Demographics
NPI:1881175107
Name:WARD, KAITLYN (DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 PROSPERITY TRL
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-4103
Mailing Address - Country:US
Mailing Address - Phone:254-709-1581
Mailing Address - Fax:
Practice Address - Street 1:2121 W HWY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4021
Practice Address - Country:US
Practice Address - Phone:254-651-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1301566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist